Medical (physical) Causes of Female Sexual Dysfunction

Case Scenario 1

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Gayle is a 25-year-old woman who comes to your office for her first Pap smear exam. She tried to have a Pap smear before, but she was unable to tolerate insertion of the speculum. She cannot use tampons during her menses due to pain at her introitus when she tries to insert the tampon. Her last boyfriend broke up with her after 6 months because she was unable to have intercourse with him due to pain at her introitus when trying to insert his penis. The patient cannot remember exactly when this pain started because she didn’t attempt to use tampons until she was 19 years old. She did not attempt intercourse until she was 21 years old. She thinks she noticed this pain the first time she attempted to insert a tampon but cannot be sure. She is extremely anxious and almost in tears about the thought of having a Pap smear, but thinks she “must” have one even though she reports being unable to ever have vaginal intercourse.

Write a brief SOAP note regarding this patient. Make sure to include your answers to these questions in your SOAP note.

1. Subjective:
   1. How will you approach this patient?
   2. What other relevant questions should you ask regarding the HPI?
   3. What other medical history questions should you ask?
   4. What other social history questions should you include? What potential situation should you address or be suspicious of?
   5. What other family history questions should you ask?
2. Objective:
   1. Write a detailed focused physical assessment on this patient.
   2. Is a pap smear necessary for this patient? Why?
   3. Explain what other test(s) you will order and perform, and discuss your rationale for ordering and performing each test.
3. Assessment/ Diagnosis:
   1. What is your presumptive diagnosis? Why?
   2. Any other diagnosis or differential diagnosis you would like to add?
4. Plan:
   1. How will you manage this patient? What interventions would you suggest?
   2. Are there any treatment or medication would you prescribe and why?
   3. Explain treatment/management guidelines including any possible side effects and/or consideration management of the diagnosis.
   4. What patient education is important to include for this patient? (Consider including pharmacological, supplements, and non pharmacological recommendations and education)
   5. What is the follow-up plan of care?

Case Scenario 1

Table 1

Table 2

Table 3

Gayle is a 25-year-old woman who comes to your office for her first Pap smear exam. She tried to have a Pap smear before, but she was unable to tolerate insertion of the speculum. She cannot use tampons during her menses due to pain at her introitus when she tries to insert the tampon. Her last boyfriend broke up with her after 6 months because she was unable to have intercourse with him due to pain at her introitus when trying to insert his penis. The patient cannot remember exactly when this pain started because she didn’t attempt to use tampons until she was 19 years old. She did not attempt intercourse until she was 21 years old. She thinks she noticed this pain the first time she attempted to insert a tampon but cannot be sure. She is extremely anxious and almost in tears about the thought of having a Pap smear, but thinks she “must” have one even though she reports being unable to ever have vaginal intercourse.

Write a brief SOAP note regarding this patient. Make sure to include your answers to these questions in your SOAP note.

1. Subjective:
   1. How will you approach this patient?
   2. What other relevant questions should you ask regarding the HPI?
   3. What other medical history questions should you ask?
   4. What other social history questions should you include? What potential situation should you address or be suspicious of?
   5. What other family history questions should you ask?
2. Objective:
   1. Write a detailed focused physical assessment on this patient.
   2. Is a pap smear necessary for this patient? Why?
   3. Explain what other test(s) you will order and perform, and discuss your rationale for ordering and performing each test.
3. Assessment/ Diagnosis:
   1. What is your presumptive diagnosis? Why?
   2. Any other diagnosis or differential diagnosis you would like to add?
4. Plan:
   1. How will you manage this patient? What interventions would you suggest?
   2. Are there any treatment or medication would you prescribe and why?
   3. Explain treatment/management guidelines including any possible side effects and/or consideration management of the diagnosis.
   4. What patient education is important to include for this patient? (Consider including pharmacological, supplements, and non pharmacological recommendations and education)
   5. What is the follow-up plan of care?